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MRI Volumetric Analysis of Breast Fibroglandular Tissue to Assess Risk of the Spared Nipple in BRCA1 and BRCA2 Mutation Carriers

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

Prophylactic nipple-areolar complex (NAC)-sparing mastectomy (NSM) in BRCA1/2 mutation carriers is controversial over concern regarding residual fibroglandular tissue (FGT) with malignant potential. The objective of this study was to model the volume of FGT in the NAC at a standard retroareolar margin (5 mm) and examine the change in this amount with a greater retroareolar margin or areola-sparing technique.

Methods

A segmentation protocol was applied to breast MRIs from 105 BRCA1/2 patients to quantify volumes of FGT for total breast and NAC. The proportion of FGT in the NAC relative to the breast was calculated as the primary outcome and was compared for 5 mm versus 10 mm retroareolar depths. The proportion of FGT in the areola was compared with the NAC.

Results

At 5 mm retroareolar thickness, residual NAC FGT comprised 1.3 % of the total breast FGT. This amount was not significantly greater than the proportion in the areola (p = 0.3, d = 0.1). Increasing the retroareolar thickness to 10 mm led to a statistically and possibly clinically significant increase in the amount of NAC FGT (p < 0.001, d = 1.1).

Conclusions

The proportion of FGT remaining in the spared NAC with a 5 mm margin is extremely small, suggesting that leaving the entire NAC would create very little added risk. Doubling the retroareolar margin may translate into a clinically meaningful increase. Overall, our findings support the safety of the current trend toward increased rates of prophylactic NSM performed in this high-risk population.

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Acknowledgment

Dr. Semple is supported by the Canadian Breast Cancer Foundation (Ontario Chapter).

Disclosure

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

    Heather L. Baltzer MSc, MD & John L. Semple MD, MSc, FRCS(C), FACS

  2. Sunnybrook Research Institute, Toronto, ON, Canada

    Olivier Alonzo-Proulx PhD, James G. Mainprize PhD, Martin J. Yaffe MSc, PhD & Ellen Warner MD, FRCPC, FACP, MSc

  3. Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada

    Olivier Alonzo-Proulx PhD & Martin J. Yaffe MSc, PhD

  4. Women’s College Research Institute, Toronto, ON, Canada

    Kelly A. Metcalfe RN, PhD, Steve A. Narod MD, FRCPC, FRSC & John L. Semple MD, MSc, FRCS(C), FACS

  5. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Kelly A. Metcalfe RN, PhD

  6. Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Ellen Warner MD, FRCPC, FACP, MSc

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  1. Heather L. Baltzer MSc, MD
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  8. John L. Semple MD, MSc, FRCS(C), FACS
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Correspondence to John L. Semple MD, MSc, FRCS(C), FACS.

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Baltzer, H.L., Alonzo-Proulx, O., Mainprize, J.G. et al. MRI Volumetric Analysis of Breast Fibroglandular Tissue to Assess Risk of the Spared Nipple in BRCA1 and BRCA2 Mutation Carriers. Ann Surg Oncol 21, 1583–1588 (2014). https://doi.org/10.1245/s10434-014-3532-x

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  • DOI: https://doi.org/10.1245/s10434-014-3532-x

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